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The Borderline personality disorder, often diagnosed among women, is one of the most contentious mental health diagnoses. Borderlines are characterized by stormy, short-lived, and unstable relationships - matched by wildly fluctuating (labile) self-image and emotional expression (affect).
Borderlines are impulsive and reckless - their sexual conduct is frequently unsafe, they binge eat, gamble, drive, and shop carelessly, and are substance abusers.
They are also often characterized by self-destructive and self-defeating behaviors, such as suicidal ideation, suicide attempts, gestures, or threats, and self-mutilation or self-injury.
Borderlines are terrified of being abandoned. They make frantic - and, usually, counterproductive - efforts to preempt or prevent abandonment, both real and imagined, by their nearest and dearest. Clinging, codependent acts are followed by idealization and then swift and merciless devaluation of the Borderline's partner.
This ever-present anxiety is connected to the Borderline's need for constant affirmation to support her gyrating sense of self-worth and her chaotic self-image. In this, the Borderline is akin to the narcissist, always on the prowl for "narcissistic supply" to shore up serious, marked, persistent, and ubiquitous deficits in self-esteem and Ego functions and to counter the gnawing emptiness at his or her core.
Hence the Borderline's mood reactivity. She shifts dizzyingly between dysphoria (sadness or depression) and euphoria, manic self-confidence and paralyzing anxiety, irritability and indifference. This is reminiscent of the mood swings of Bipolar Disorder patients. But Borderlines are much angrier and more violent. They usually get into physical fights, throw temper tantrums, and have frightening rage attacks.
When stressed, many Borderlines become psychotic, though only briefly (psychotic micro-episodes), or develop transient paranoid ideation and ideas of reference (the erroneous conviction that one is the focus of derision and malicious gossip). Dissociative symptoms are not uncommon ("losing" stretches of time, or objects, and forgetting events or facts with emotional content).
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